Hand surgery : an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand
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Randomized Controlled Trial Comparative Study
Short versus long-acting local anaesthetic in open carpal tunnel release: which provides better preemptive analgesia in the first 24 hours?
Open carpal tunnel release is commonly performed under local anaesthesia. No study has compared intra-operative short- versus long-acting local anaesthetics as preemptive analgesics in carpal tunnel surgery. In this single-blinded prospective study, 100 consecutive carpal tunnel releases were performed by a single surgeon at one institution with either lignocaine (n = 50) or ropivacaine (n = 50). ⋯ The time to the first postoperative pain was significantly shorter in the lignocaine group (5.58 vs. 9.17 hours, p < 0.035). There were no significant difference in the incidence of poor first night's sleep (16% vs. 26%, p = 0.28) or mean pain scores in the first day (3.6 vs. 2.9, p = 0.16). Existing evidence advocates for long-acting intraoperative local anaesthetic because it results in a longer duration of postoperative analgesia, however, our study suggests that it may also result in a poorer first night's sleep.
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Comparative Study
The beauty of stability: distal radioulnar joint stability in arthroscopic triangular fibrocartilage complex repair.
The triangular fibrocartilage complex (TFCC) has an important role in the stability of the distal radioulnar joint (DRUJ) stability. We designed a new method of TFCC tear repair that has satisfactory post-operative DRUJ stability. From May 2004 to August 2010, 14 patients who underwent this operation were reviewed. ⋯ Transosseous suture via inside-outside technique was used for repair. At the final follow-up, all 14 patients have soft end point with < 5 mm translations of the DRUJ shown by the stress test. Based on this small sample with satisfactory outcome assessed by the Mayo modified wrist score and DRUJ stability, we recommend TFCC tear in sigmoid notch, which has a higher chance of DRUJ instability, to be repaired by transosseous suture.
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Hamate hook fractures are rare injuries but appear to occur frequently in underwater rugby, the reason for which was investigated in this study. High-level underwater rugby players with hook fractures diagnosed during a five-year interval (2005-2010) were studied retrospectively. Medical data on these patients were reviewed for information on the mechanism of injury, type of fracture, radiological imaging, treatment, and outcome. ⋯ Conservative treatment resulted in delayed healing or non-union, wherefore fragment excision and open reduction and internal fixation was performed in ten and five patients, respectively, while two patients declined surgery. After surgery, all patients were able to play underwater rugby again. In underwater rugby, hook fractures occur frequently due to high and repeated forces applied to the leading hand during games.
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We report a case of rotatory subluxation of the metacarpophalangeal joint (MCPJ) of the finger. A 40-year-old man sustained an open injury to his index finger following an explosive injury. ⋯ Treatment was by open reduction and repair of the collateral ligament and the extensor tendon. A high level of clinical suspicion is needed to diagnose this entity.
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Embedded ring injury is rarely encountered in clinical practice, and most of the few reported cases share common features, including deliberate neglect, mental illness, poor social support, female gender, and adult age group. Ischemia has never been reported in such injuries. Here, we report the case of a 16-year-old girl who presented with a completely embedded ring in the right index finger and a partially embedded ring in the left ring finger. Revascularization after ring embedment probably explains the intact vessel that was observed on the outer aspect of the embedded ring during surgical exploration of the right index finger.